Anti-vaccine propaganda, and the pseudoscience that sustains it, has been around as long as there have been vaccines. Rather than spreading fears of being turned into cows, or at least developing bovine diseases, modern day deniers are morel likely to invoke the findings of research performed by scientists and medical doctors with apparently legitimate credentials. This modern day anti-vaccine movement arguably entered a new and more effective phase with the publication of Andrew Wakefield’s infamous, fraudulent, and now retracted 1998 paper in The Lancet. Though thoroughly disproved by numerous studies since it’s publication, it played a huge role in establishing a link between the MMR vaccine and autism in the minds of a generation of parents.
This specter of a link between the MMR vaccine and autism has resulted in countless parents losing confidence in the safety of that vaccine, as well as the vaccine program in general. There was an immediate and significant spike in vaccine hesitancy and refusal, which caused major outbreaks of vaccine preventable illnesses across the world. The damage is ongoing, as Wakefield continues to find new victims.
Since the MMR scare began in England, there have been numerous outbreaks of measles across Europe and the rest of the world. The United States, as readers know all too well, has not gone unscathed. In England, the population of underimmunized children who were born in the years after Wakefield’s publication and the subsequent sensationalized reaction from the press, a so-called “Wakefield cohort”, are now entering college. Not surprisingly, cases of the mumps, the second “M” in the MMR vaccine, are beginning to spike again now that this cohort is clumped together in large classrooms and dorms.
According to Public Health England, there were over 5,000 mumps cases in 2019. This was up from just over 1,000 cases in 2018, and is the highest total in a decade. To give a little perspective to these numbers, which are bad enough, England documented about 50,000 total cases of mumps in 2004 and 2005.
The current spike doesn’t seem to be letting up just yet. In the first month of 2020, over 500 cases were identified. Most of the recent cases have occurred in individuals who were not immunized, which shouldn’t come as a surprise. That being said, the MMR vaccine is not as effective in conferring protection against mumps as it is against measles. Even with two doses, as recommended by the CDC, you only get up to about 85% chance of immunity. This is below what is needed for herd immunity, so even a best case scenario of 100% uptake would still allow small outbreaks to happen from time to time.
An outbreak of over 5,000 cases isn’t small and is clearly the result of insufficient vaccination rates. The NHS has initiated a campaign to catch kids up on their MMR vaccine, which is even more badly needed because of a surge in measles cases leading to the loss of their WHO “measles-free” status after only three years of receiving it. Obviously healthcare professionals in England are currently dealing with a much bigger issue in the SARS-CoV-2 pandemic, leaving me to worry that this problem isn’t going to be solved any time soon, and that there may be more outbreaks of mumps (and measles) as people shelter in place.
If you want more detail on what mumps is, how you catch it, and what it can do, check out my 2014 post on the subject. In a nutshell, mumps isn’t as serious or potentially life threatening as measles, but that doesn’t mean it’s a walk in the park. Besides the classic presentation of swollen and very tender parotid glands, mumps can cause inflammation of the brain, testes, and ovaries, as well as seizures and transient paralysis. Long term problems, such as permanent neurologic injury or sterility, are rare, but they do happen.
I truly hope that this post finds you all happy and healthy in such uncertain times. As a pediatrician, and because children tend to have milder COVID-19 presentations, I have thus far been spared. My day to day life as a hospitalist has changed a great deal, and the contingency plans that my hospital, and my colleagues, have had to develop are quite distressing. But it is best to be prepared for the worse case scenarios. If only certain governments had done the same. Well, good luck everyone!